To date, Section 1115 waivers that condition Medicaid eligibility on beneficiaries' meeting work and community engagement (CE) requirements have been approved by the Centers for Medicare & Medicaid Services (CMS) for eight states: Arizona, Arkansas, Indiana, Kentucky, Maine, Michigan, New Hampshire, and Wisconsin. Some of the waiver applications and approvals do not include projections of coverage impacts, an important consideration as these waivers move forward. Information that is now available on actual experience in Arkansas1 offers key insights for other states. This brief provides new estimates of potential impacts of Michigan's work requirement based on the Arkansas experience and data available on the composition and demographics of the Michigan beneficiaries subject to the requirement, with adjustments that reflect differences between the states.
- An estimated 61 percent of the 680,000 people enrolled in the Healthy Michigan Plan (HMP), 2 which covers the State's Medicaid expansion group, will be required to selfreport an exemption or qualifying activities. For the remaining 39 percent, the State will provide exemptions using information it already has available on beneficiaries (referred to as administrative determinations in this brief).
- An estimated 174,000 people each month will be found noncompliant for failure to meet the reporting obligations of Michigan's work requirement.
- Depending on how many months their reporting issues continue, an estimated 61,000 to 183,000 people -- between 9 and 27 percent of the State's Medicaid expansion population -- will lose Medicaid coverage in Michigan over a one-year period. The high end is consistent with the experience in Arkansas to date, but the range reflects the uncertainty of impacts as work requirements are implemented and policies and practices evolve over time.
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